Provider Demographics
NPI:1790957173
Name:MUDASIRU A CAREW DO PA
Entity Type:Organization
Organization Name:MUDASIRU A CAREW DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUDASIRU
Authorized Official - Middle Name:ADEGBOLA
Authorized Official - Last Name:CAREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-6276
Mailing Address - Street 1:12600 PEMBROKE ROAD
Mailing Address - Street 2:STE 204
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-987-6276
Mailing Address - Fax:954-430-5800
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:STE 204
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-987-6276
Practice Address - Fax:954-430-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006WCOtherBLUE CROSS AND BLUE SHIELD
FLK5125Medicare PIN